Football and dementia: looking at other factors – Authors' reply
Authors: Peter Ueda, Björn Pasternak, Carl-Emil Lim, Martin Neovius, Jonas F Ludvigsson, Henrik Svanström
Journal: The Lancet Public Health (2023)

We thank Uzoigwe and Bin Qadir for their reflections on our Article1Ueda P Pasternak B Lim CE et al.Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study.Lancet Public Health. 2023; 8: e256-e265Summary Full Text Full Text PDF PubMed Google Scholar regarding potential factors such as education and height. As described in our Article,1Ueda P Pasternak B Lim CE et al.Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study.Lancet Public Health. 2023; 8: e256-e265Summary Full Text Full Text PDF PubMed Google Scholar we have previously presented data on educational outcomes among male elite football players and male general population controls.2Ueda P Pasternak B Svanström H et al.Alcohol related disorders among elite male football players in Sweden: nationwide cohort study.BMJ. 2022; 379e074093PubMed Google Scholar Here we present more data on variables that might be associated with risk of neurodegenerative disease (including education and height) among men from the Swedish general population (previously published2Ueda P Pasternak B Svanström H et al.Alcohol related disorders among elite male football players in Sweden: nationwide cohort study.BMJ. 2022; 379e074093PubMed Google Scholar), outfield players, and goalkeepers. We used data from assessments during military conscription among male football players and men from the general population born in 1951–87, and from those with educational data and income data available at age 40–44 years, as previously described.2Ueda P Pasternak B Svanström H et al.Alcohol related disorders among elite male football players in Sweden: nationwide cohort study.BMJ. 2022; 379e074093PubMed Google Scholar Elite football players had higher scores for stress resilience, muscle strength, and cardiorespiratory capacity during military conscription (appendix), and cognitive ability scores were similar for both male football players and men from the general population. Elite football players (born in 1946–79) had higher incomes and were more likely to receive secondary or short tertiary education but were less likely to receive long tertiary education. The findings were similar for outfield players and goalkeepers. Additionally, goalkeepers were taller than outfield players and men from the general population. Data on income, education, or military conscription results were not available for the older birth cohorts, who had experienced most of the neurodegenerative disease outcomes in our study.1Ueda P Pasternak B Lim CE et al.Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study.Lancet Public Health. 2023; 8: e256-e265Summary Full Text Full Text PDF PubMed Google Scholar We could therefore not account for these variables in analyses of neurodegenerative disease. The applicability of these findings, in particular regarding income and educational outcomes, to contemporary football players is uncertain. In summary, educational outcomes did not differ substantially between male elite football players and men from the general population born in 1946–79. Although better gestational, child, and adolescent developmental surroundings (which could affect risk of neurodegenerative disease later in life) might affect height, we find it unlikely that a better early life environment has led some individuals to become goalkeepers (due to being taller), while those with less optimal development have become outfield players. We hope that these additional data can inform the interpretation of our study and other studies on neurodegenerative disease among football players. We declare no competing interests. Download .pdf (.08 MB) Help with pdf files Supplementary appendix Football and dementia: looking at other factorsPeter Ueda and colleagues1 make an important contribution to the literature regarding a potentially long-term consequence of football, possibly related to heading the ball. Physical activity is generally considered healthy, so finding an increased risk of neurodegenerative disease from heading the ball is surprising; but has been replicated by other studies. The authors observed increased risk of neurodegenerative disease, specifically dementia but not other neurodegenerative conditions, in outfield football players. Full-Text PDF Open Access